Introduction

Vulvitis is not a disease in itself, but rather an inflammation of the skin folds of the vulva, the exterior of the female genitalia. 

Although vulvitis may have an unknown cause, most of the time it is a symptom of another condition or disease. 

Common conditions that can lead to vulvitis are:

• Yeast infections (Candidiasis)
• Sexually transmitted infections (STIs)
• Bacterial vaginosis
• Viral infections (e.g., HPV or herpes)
• Skin conditions (e.g., eczema or psoriasis)
• Hormonal changes

It can also be caused by an unhealthy lifestyle or some common behaviours that will be further explored below.

Vulvitis can affect women at any age, especially young girls (before puberty) and postmenopausal women. This is due to the low levels of oestrogen in these women that make the tissues around the vulva thin and dry. 

In most cases, vulvitis is relatively easy to treat, usually resolving in a few days. 

Is vulvitis common?

Vulvitis is estimated to affect 10-20% of women worldwide. Although it is frequently underreported due to embarrassment or lack of awareness, it is considered relatively common. Although accurate numbers are not available, the high frequency of related conditions, such as yeast infections, STIs, and dermatological conditions, suggests that vulvitis is a common issue in the UK.

What causes vulvitis?

Vulvitis can be caused by a number of factors:

• Certain antibiotics
• Diet, specifically sweets, bread, cheese, as well as alcoholic beverages
• A weakened immune system
• Allergy, infection, or injury in the genital area
• Stress, anxiety, and lack of sleep
• Soaps, laundry detergents, or any other product with perfume
• STIs (e.g., gonorrhoea or chlamydia)
• Pregnancy and breastfeeding
• Poor hygiene
• Urinary and faecal incontinence

How do I know if I have vulvitis?

Although symptoms of vulvitis are not very specific, they typically include redness, swelling, itching, soreness, and pain. In some cases, there may also be scaly or white patches on the vulva.

For a formal diagnosis, it’s always best to see a healthcare professional. Typically, your doctor will take your medical history and perform a physical examination of your vulva. This may be followed by blood tests, swabs and/or urine tests to identify possible infections. Very rarely you will need to do a biopsy or colposcopy (an exam in which your doctor examines your cervix, vulva, and vagina with an instrument that works as a magnifying glass called a colposcope). This usually happens if you are not responding to treatment or your doctor detects lesions of unknown origin.

What can I do at home?

Although dependent on the cause, vulvitis treatment has high success rates and symptoms can subside in a few days. Most of the time it is not serious and will resolve on its own.

Typically, vulvitis is treated by doctors with steroids, anti-histamines (anti-allergy medications) or oestrogen (hormone) therapy. However, there are natural solutions you can try at home to help treat the condition and alleviate symptoms.

Home remedies that have been shown to help with vulvitis are:

• Pau D’arco, the inner bark from the South American Tabebuia tree: boil 10-20 minutes and take a teaspoon 2-3 times a day. Similarly to garlic, Pau D’arco has antifungal, antibacterial and anti-inflammatory properties. In addition, it helps boost the immune system and promotes faster healing due to its antioxidant properties. Pau d’Arco, also known as Taheebo or Lapacho, can be found in the UK in most wellness and natural supplement stores. Please be aware that people taking blood thinning medication (warfarin, rivaroxaban/ apixaban, clopidogrel) or anti-inflammatories such as ibuprofen, diclofenac, or naproxen, should not consume Pau d’Arco as it may increase risk of bleeding or damage the liver or kidneys
• In the shower: rinse with tea or a mixture of vinegar and water. Due to its antioxidant and anti-inflammatory properties, tea helps reduce discomfort from the irritation of the vulvar area and promotes healing. Vinegar (especially apple cider vinegar) is known for its antimicrobial properties, which can slow down bacteria/ yeast replication. It also helps re-establish the acidic pH of the vulva and, when diluted in water, helps with itching resulting from inflammation
• In the bath: sit in tepid, not hot, water for 15-20 minutes (commonly called sitz baths). Add perfume-free oils to help moisturize the vulva and/or a cup of white vinegar to relieve itching. Please note that vinegar must always be diluted in water; otherwise, it can worsen skin irritation and cause a burning sensation
• Restoring sleep and regular physical activity. Compromised psychological well-being weakens the immune system and can lead to hormone imbalance. Ensuring restful sleep and practising regular exercise are fundamental to combat stress, anxiety, and depression. Relaxation practices such as yoga and meditation also help regulate the nervous system and reduce stress and anxiety levels
• Food also plays a major role in healing; not just in vulvitis but for any condition. Having half a cup of yoghurt every day will help regulate yeast levels in the body. Yoghurt is a natural probiotic that helps balance the bacteria in the body
• Other foods that have anti-inflammatory properties may aid healing, such as whole grains (rice, quinoa, oatmeal); fruits and vegetables with antioxidant components (berries, apples, apricots, and mangos, as well as spinach, kale and arugula); fatty fish such as salmon and sardines; nuts and seeds, like walnuts, flaxseeds and chia seeds; citrus fruits (oranges, lemons, grapefruit); ginger and turmeric; and garlic

Additionally, the following products and practices should be avoided:

• Rubbing – causes further irritation, patting is advised
• Scrubbing – it’s best to rinse gently rather than scrubbing
• Washing genitals with soap – perfumed soaps and oils can be hard on the skin, especially when it is already inflamed
• Using tampons or sanitary pads – these can worsen irritation as they don’t allow the vulvar skin to breathe
• Not drying the vulva properly – humidity promotes the replication of bacteria
• Tight or synthetic underwear – loose cotton clothes are preferable
• Eating processed and spicy food, refined carbohydrates, food that is rich in sugar, and alcoholic and caffeinated beverages
• Not drinking enough water – hydration is vital for eliminating toxins in the body. Herbal teas can also be beneficial

Not all these home remedies will work for everyone. You must monitor how your body reacts and understand what works for you (and what doesn’t). However, home remedies should provide some symptom relief in 3-5 days. If symptoms persist, you develop a high temperature, have smelly or green discharge or vulvitis is affecting your life quality, it is highly recommended to seek the help of a healthcare professional such as a gynaecologist. It may be necessary to find out the root cause(s) of vulvitis and have targeted treatment.

Should I stop having sexual relations while I or my partner have vulvitis?

Having sex with vulvitis can worsen inflammation in the genital area and tends to cause pain. It is advisable to avoid sexual relations until symptoms improve. In addition, condoms with lubricant should be avoided while the vulva is still healing as they can cause irritation and delay the healing process.

If the person with vulvitis is using an oil-based remedy, this can increase the risk of condom tear and therefore reduce protection.

Can I prevent vulvitis?

Vulvitis is a condition with many possible causes. However, some lifestyle behaviours help reduce the probability of developing inflammation in the vulvar area. Having good genital hygiene, refraining from using perfumed products, and avoiding tight clothes that prevent the skin from breathing and prolonged exposure to humidity are all important measures to adopt for healthy genitalia. Safe sexual practices are crucial to avoid sexually transmitted infections.

Having a balanced diet rich in antioxidant and probiotic foods, and exercising regularly for your mental health are also vital to promote overall good health, including gynaecological health.

Summary

• Vulvitis is a common condition worldwide, including in the UK; however, most of the time, it is undetected. Pubescent and menopausal women are more vulnerable
• Vulvitis is not usually serious and is easily treated; however, finding out the cause may be necessary
• Common symptoms include redness, swelling and itching of the outer skin of the female genitals
• Home remedies to relieve symptoms include Pau d’Arco, diluted vinegar rinses/baths and avoiding perfumed soaps/oils
• Lifestyle plays a major role: adequate sleep and physical activity are vital to alleviate stress and therefore inflammationYoghurt, whole grains, antioxidant fruits and leafy greens can help with symptoms. Sugar-rich foods, caffeine, alcohol and processed food should be avoided
• If these home remedies don’t alleviate symptoms in a few days, it is advised to seek the help of a healthcare professional